Disclosure and compensation programs are a leading alternative to traditional medical liability. Patients want to know about medical errors, especially errors that directly harm them. Although disclosing an error and its consequences to a patient is difficult, the benefits of disclosing errors to patients are multiple. Our overall goal is to determine how to make disclosure and compensation a process that will not only serve the needs of individual patients, but take more advantage of the patient's experience to help hospitals change their systems and improve safety for subsequent patients. To meet this goal we will: 1) conduct a 3-year study of disclosure and compensation in the University of Texas System with measures of disclosure, malpractice, and impact on safety at three points in time (baseline, after initial disclosure training/before implementation of best practices for using disclosure to improve safety, and after implementation of these best practices);2) host a conference of national experts during year two to identify best practices for using disclosure to improve hospital safety;and 3) implement, evaluate, and disseminate these best practices (with a focus on incorporating patients and families into efforts to understand why errors occur). The products of this study will include: best practices for using disclosure and patients'perspectives to improve patient safety;a new survey to measure both safety culture and error disclosure culture;and an assessment of how disclosure and compensation influences traditional tort outcomes such as claims, suits, time to resolution, payments, and overall expense. PUBLIC HEALTH RELEVANCE: Our overall goal is to determine how to make disclosure and compensation a process that will not only serve the needs of individual patients, but take more advantage of the patient's experience to help hospitals change their systems and improve safety for subsequent patients. To meet this goal we will: 1) conduct a 3-year study of disclosure and compensation in the University of Texas System with measures of disclosure, malpractice, and impact on safety at three points in time (baseline, after initial disclosure training/before implementation of best practices for using disclosure to improve safety, and after implementation of these best practices);2) host a conference of national experts during year two to identify best practices for using disclosure to improve hospital safety;and 3) implement, evaluate, and disseminate these best practices (with a focus on incorporating patients and families into efforts to understand why errors occur). The products of this study will include: best practices for using disclosure and patients'perspectives to improve patient safety;a new survey to measure both safety culture and error disclosure culture;and an assessment of how disclosure and compensation influences traditional tort outcomes such as claims, suits, time to resolution, payments, and overall expense.